Teaching models in an ambulatory training program
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Abstract
Ambulatory care training is increasingly important in internal medicine. Such training centers on the practice where residents and faculty see their patients; thus, features of the practice model influence what residents learn. A resident-faculty group practice affiliated with a division of general internal medicine has many advantages. In such a practice, learning centers on resident-patient interactions, around which a comprehensive teaching program must be built. Major features of such a program include the mentoring of residents by faculty who work with them longitudinally and the presence of a well-balanced structured curriculum addressing clinical and nonclinical topics related to patient care. Teaching residents to interact and communicate with patients is crucial; approaches include role-modeling by faculty, use of videotaping, and role-playing and other innovative methods. Feedback is integral to learning and helps shape the attitudes and values that permeate residents’ practices.
Key words
ambulatory care education residents interpersonal skills teaching modelsReferences
- 1.Karpf M, Levy GS. Training internists for the changing medical scene. Ann Intern Med. 1986;104:567–9.PubMedGoogle Scholar
- 2.Gellhorn A. Graduate medical education in internal medicine. Ann Intern Med. 1986;104:569–70.PubMedGoogle Scholar
- 3.Lewis CE. Training in internal medicine: time to retool the factory? Ann Intern Med. 1986;104:570–2.PubMedGoogle Scholar
- 4.Schroeder SA, Showstack JA, Gerbert B. Residency training in internal medicine: time for a change? Ann Intern Med. 1986;104:554–61.PubMedGoogle Scholar
- 5.Branch WT. Expanded medical education in primary care—is this the next step? J Gen Intern Med. 1986;1:269–70.PubMedCrossRefGoogle Scholar
- 6.Perkoff GT. Teaching clinical medicine in the ambulatory setting, an idea whose time may have finally come. N Engl J Med. 1986;314:27–31.PubMedCrossRefGoogle Scholar
- 7.Association of American Medical Colleges. Physicians for the 21st century—the G.P.E.P. report. Washington, DC: AAMC, 1984.Google Scholar
- 8.Lawrence RS. The goals for medical education in the ambulatory setting. J Gen Intern Med. 1988;3(suppl):S15-S25.PubMedCrossRefGoogle Scholar
- 9.Shine KI. Innovations in ambulatory care education. N Engl J Med. 1986;314:52–3.PubMedCrossRefGoogle Scholar
- 10.Forrow L, Wartman SA, Brock DW. Science, ethics and the making of clinical decisions. Implications for risk factor intervention. JAMA. 1988;259:3161–7.PubMedCrossRefGoogle Scholar
- 11.Guttmacher S, Teitelman M, Chapin G. Ethics and preventive medicine: the case of borderline hypertension. Hastings Center Rep. 1981;11:12–20.CrossRefGoogle Scholar
- 12.Dawson N. Systematic errors in medical decision making. J Gen Intern Med. 1987;2:183–7.PubMedCrossRefGoogle Scholar
- 13.Pauker SG, Kassirer JP. Decision analysis. N Engl J Med. 1987;316:250–8.PubMedCrossRefGoogle Scholar
- 14.Hiatt HH. Protecting the medical commons: who is responsible? N Engl J Med. 1985;293:235–41.CrossRefGoogle Scholar
- 15.Eisenberg JM. The internist as gatekeeper: preparing for a new role. Ann Intern Med. 1985;102:537–43.PubMedGoogle Scholar
- 16.Gillick MR. Talking to patients about risk. J Gen Intern Med. 1988;3:166–70.PubMedGoogle Scholar
- 17.Bedell SE, Delbanco TL. Choices about cardiopulmonary resuscitation in the hospital. When do physicians talk with patients? N Engl J Med. 1984;310:1089–93.PubMedCrossRefGoogle Scholar
- 18.Wanzer SH, Adelstein SJ, Cranford RE, et al. The physician’s responsibility toward hopelessly ill patients. N Engl J Med. 1984;310:955–9.PubMedCrossRefGoogle Scholar
- 19.Perkins HS. Ethics at the end of life: practical principles for making resuscitation decisions. J Gen Intern Med. 1986;1:170–6.PubMedGoogle Scholar
- 20.Novack D. Therapeutic aspects of the clinical encounter. J Gen Intern Med. 1987;2:346–55.PubMedCrossRefGoogle Scholar
- 21.Suchman A, Matthews D. What makes the patient-doctor relationship therapeutic? Ann Intern Med. 1988;108:125–30.PubMedGoogle Scholar
- 22.Greenfield S, Kaplan S, Ware JE Jr. Expanding patient involvement in care: effects on patient outcomes. Ann Intern Med. 1985;102:520–8.PubMedGoogle Scholar
- 23.Friedman RH, Posen JT. The academic viability of general internal medicine: the views of department of medicine chairmen. Ann Intern Med. 1985;103:439–44.PubMedGoogle Scholar
- 24.Walker JEC, Murawski BJ, Thorn GW. An experimental program in ambulatory medical care. N Engl J Med. 1964;271:63–68.PubMedCrossRefGoogle Scholar
- 25.Berarducci AA, Delbanco TL, Rabkin MT. The teaching hospital and primary care. Closing down the clinics. N Engl J Med. 1975;292:615–20.PubMedCrossRefGoogle Scholar
- 26.Delbanco TL, Parker JN. Primary care at a teaching hospital: history, problems and prospects. Mt. Sinai J Med. 1978;45:628–45.PubMedGoogle Scholar
- 27.Kosecoff J, Fink A, Brook RH, et al. General medical care and the education of internists in university hospitals. An evaluation of the teaching hospital general medicine group practice program. Ann Intern Med. 1985;102:250–7.PubMedGoogle Scholar
- 28.Epstein A, Pollock DK. The HMO and the academic medical center. HMO Practice. 1988;2:133–8.Google Scholar
- 29.Rosenblatt RA. Current successes in medical education beyond the bedside. J Gen Intern Med. 1988;3(suppl):544–61.Google Scholar
- 30.Goroll AH, Stoeckle J, Goldfinger SE, et al. Residency training in primary care internal medicine. Ann Intern Med. 1975;83:872–7.PubMedGoogle Scholar
- 31.Goodson JD, Goroll AH, Barsky AJ, et al. The training of physicians outside the hospital. Arch Intern Med. 1986;146:1805–9.PubMedCrossRefGoogle Scholar
- 32.Schroeder SA, McPhee SJ. Training internists in ambulatory settings: four problems to resolve. Arch Intern Med. 1986;146:1685–6.PubMedCrossRefGoogle Scholar
- 33.Day SC, Cook EF, Nesson HR, Wolf MA, Goldman L. A learning-curve approach to the self-assessment of internal medicine training. J Med Educ. 1984;59:672–5.PubMedGoogle Scholar
- 34.McPhee SJ, Mitchell TF, Schroeder SA, et al. Training in a primary care internal medicine residency program. The first ten years. JAMA. 1987;258:1491–5.PubMedCrossRefGoogle Scholar
- 35.Kantor SM, Griner PF. Educational needs in general internal medicine as perceived by prior residents. J Med Educ. 1981;56:748–56.PubMedGoogle Scholar
- 36.Kern DC, Parrino TA, Korst DR. The lasting value of clinical skills. JAMA. 1985;254:70–6.PubMedCrossRefGoogle Scholar
- 37.Bazuin CH, Yonke A. What and how to teach in a primary care setting. J Med Educ. 1980;55:874–6.PubMedGoogle Scholar
- 38.Stritter FT, Hain JD, Grimes DA. Clinical teaching reexamined. J Med Educ. 1975;50:876–82.PubMedGoogle Scholar
- 39.Yonke AM. The art and science of clinical teaching. Med Educ. 1979;13:86–90.PubMedGoogle Scholar
- 40.McLeod PJ, Harden RM. Clinical teaching strategies for physicians. Med Teacher. 1985;7:173–89.Google Scholar
- 41.Skeff KM. Enhancing teaching effectiveness and vitality in the ambulatory setting. J Gen Intern Med. 1988;3(suppl):S26-S33.PubMedCrossRefGoogle Scholar
- 42.Rosenblatt RA, Cherkin DC, Schneeweiss R, Hart LG. The content of ambulatory medical care in the United States: an interspecialty comparison. N Engl J Med. 1983;309:892–7.PubMedCrossRefGoogle Scholar
- 43.Cypress BK. Patterns of ambulatory care in internal medicine: the national ambulatory care survey, Hyattsville, MD: National Center for Health Statistics, 1984; DHEW publication no. CPHS 84-1741 (Vital and Health Statistics; series 13, no. 80).Google Scholar
- 44.Branch WT, ed. Office practice of medicine. Philadelphia: WB Saunders, 1987.Google Scholar
- 45.Goroll A, May LA, Mulley AG, eds. Primary care medicine. Philadelphia: J.B. Lippincott, 1987.Google Scholar
- 46.Hatem CJ, Lawrence RS, Arky RA. A curriculum for the clinical education and training of physicians in primary care medicine. Hartford, CT: National Fund for Medical Education, 1978.Google Scholar
- 47.Guilbert J-J. How to devise educational objectives. Med Educ. 1984;18:134–41.PubMedGoogle Scholar
- 48.Tough A: The adult’s learning projects. 2nd ed. Toronto, ON: Ontario Institute for Studies in Education, 1979.Google Scholar
- 49.Knowles M. The modern practice of adult education. New York: Association Press, 1980.Google Scholar
- 50.Cross P. Adults as learners. San Francisco: Jossey-Bass, 1981.Google Scholar
- 51.Tosteson DC. The Oliver Wendell Holmes Society: a new pathway to general medical education at Harvard Medical School. In Barrows HS, Peters MJ, eds. How to begin reforming the medical curriculum: report of a conference, June 14–15, 1984. Springfield, IL: Southern Illinois University School of Medicine, 1984.Google Scholar
- 52.Engel GE. The deficiencies of the case presentation as a method of clinical teaching. N Engl J Med. 1971;294:20–4.CrossRefGoogle Scholar
- 53.Kassirer JP. Teaching clinical medicine by iterative hypothesis testing. N Engl J Med. 1983;309:921–3.PubMedCrossRefGoogle Scholar
- 54.Lipkin M, Quill TE, Napodano RJ. The medical interview: a core curriculum for residencies in internal medicine. Ann Intern Med. 1984;100:277–84.PubMedGoogle Scholar
- 55.Lipkin M. The medical interview and related skills. In: Branch WT, ed. Office practice of medicine, 2nd ed. Philadelphia: W. B. Saunders, 1987.Google Scholar
- 56.Davis JC, Dans PE. The effect on instructor—student interaction of video replay to teach history-taking skills. J Med Educ. 1981;56:864–6.PubMedGoogle Scholar
- 57.Ende J. Feedback in clinical medical education. JAMA. 1983;250:777–81.PubMedCrossRefGoogle Scholar
- 58.Branch WT. Doctors as “healers”: striving to reach our potential. J Gen Intern Med. 1987;2:356–9.PubMedCrossRefGoogle Scholar
- 59.Makadon HJ, Wilkerson L, Williamson P. AIDS for primary care givers. A faculty development course: introduction: strategies for implementation, The AIDS Task Force of the Society of General Internal Medicine, September 1988.Google Scholar
- 60.Lewin K. Group decision and social change. In: Newcomb TM, Hartley EL, eds. Readings in social psychology. New York: Holt, Rinehart and Winston, 1947.Google Scholar
- 61.Patient/Doctor Curriculum; Year I, Harvard Medical School, Class of 1992, prepared by W Branch, E McLaughlin, D Levy.Google Scholar
- 62.Greenberg LG, Jewett LS. Committment to teaching: myth or reality? South Med J. 1983;76:910–2.PubMedGoogle Scholar
- 63.Miller GE. On teaching teachers. Med Educ. 1985;19:331.Google Scholar
- 64.Guilbert J-J. Teacher training workshops in education: summary of 15 years’ personal experience. Med Educ. 1985;19:332–43.PubMedCrossRefGoogle Scholar
- 65.Skeff DM, Stratos G, Campbell M, et al. Evaluation of the seminar method to improve clinical teaching. J Gen Intern Med. 1986;1:315–22.PubMedCrossRefGoogle Scholar
- 66.Bazuin CH, Yonke AM. Improvement of teaching skills in a clinical setting. J Med Educ. 1978;53:377–82.PubMedGoogle Scholar
- 67.Wilkerson LA, Lesky L, Medeo FJ, The resident as teacher during work rounds. J Med Educ. 1986;61:823–9.PubMedGoogle Scholar
- 68.Foley RM, Smilansky J, Yonke A. Teacher-student interaction in a medical clerkship. J Med Educ. 1979;54:622–6.PubMedGoogle Scholar